Tariciotti 2018.
| Study characteristics | |||
| Patient Sampling | Retrospective study of CSF samples from 1137 out‐ and inpatients at the New York Presbyterian Hospital between 2005 and 2017. The study included 264 participants with ADD, 53 MCI, 65 DLB, 53 FTD, 31 vascular dementia, 21 progressive supranuclear palsy, 14 corticobasal degeneration, 218 NPH, 30 CJD, 37 non‐specific psychaitric disorders, and 230 with subjective memory complaints. Participants with NPH were only included where they underwent ventriculoperitoneal shunt placement. Separate data were available for the performance of biomarkers in distinguishing between ADD from FTD or DLB. We did not include data on performance of the index test to discriminate AD participants from cognitively healthy participants. Sampling procuedure: participants were ascertained from medical records. Exclusion criteria: dementia of uncertain aetiology, or partially documented dementia diagnosis. |
||
| Patient characteristics and setting | Diagnoses were made by several different neurologists using standard criteria (see reference standar below). Sex: 106 male, 158 female for ADD; 33 male; 20 female for FTD; 33 male; 32 female for DLB, 18 male; 13 female for vascular dementia; 124 male, 94 female for NPH; 20 male, 10 female for CJD. Age mean (SD): 67.7 ± 10.4 for ADD; 63.6 ± 8.8 for FTD; 73.1 ± 7.9 for DLB; 70.2 ± 8.9 for vascular dementia; 76.8 ± 8.0 for NPH; 67.0 ± 9.9 for CJD. There was a significant difference in age between ADD and other dementia sub‐types. MMSE: Not reported. Disease duration (y): not reported. Sources of recruitment: medical records of in‐ and outpatients at the New York Presbyterian Hospital. |
||
| Index tests | Patients gave CSF samples. The samples were collected in polypropylene tubes, centrifuged, aliquoted, and stored at ‐80°C and analysed. Abeta42 was measured using enzyme‐linked immunosorbent assays, obtained from ADmark® ELISA kit. Threshold: pre‐specified at <500 pg/ml. Were the index test results reported without knowledge of the reference standard? [Unlcear]. |
||
| Target condition and reference standard(s) |
Target condition: Alzheimer's disease (differential diagnosis of ADD from "other dementia", vascular dementia, DLB, FTD, CJD, and NPH with AD pathology). Reference standard: NINCDS‐ADRDA criteria for ADD. FTD was diagnosed according to the Neary criteria, DLB according to McKeith criteria, referred criteria for CJH, NINDS‐society for Progressive Supranuclear Palsy for PSP, Boeve criteria for CBD, and vascular dementia according to the NINDS‐AIREN criteria. It was unclear if the reference standard was blinded to the results of the index test. |
||
| Flow and timing |
AD vs other dementia (n=749) AD=264; other dementia=485; Sensitivity=81%; Specificity=54% (Table 2, p381) TP=197; FP=233; FN=46; TN=273 (calculated in RevMan5) AD vs DLB (n=329) AD=264; DLB= 65; Sensitivity=81%; Specificity=60% (Table 2, p381) TP=214; FP=26; FN=50; TN=39 (calculated in RevMan5) AD vs FTD (n=317) AD=264; FTD=53; Sensitivity=81%; Specificity=40% (Table 2, p381) TP=214; FP=32; FN=50; TN=21 (calculated in RevMan5) AD vs CJD (n=294) AD=264; CJD= 30; Sensitivity=81%; Specificity=40% (Table 2, p381) TP=214; FP=18; FN=50; TN=12 (calculated in RevMan5) AD vs vascular dementia (n=295) AD=264; vascular dementia=31; Sensitivity=81%; Specificity=39% (Table 2, p381) TP=214; FP=19; FN=50; TN=12 (calculated in RevMan5) Missing data: 121 (10.7%) excluded due to incomplete or uncertain diagnosis. The interval between established clinical diagnosis and CSF sample collection was not reported. |
||
| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | No | ||
| Was a case‐control design avoided? | Yes | ||
| Did the study avoid inappropriate exclusions? | No | ||
| Could the selection of patients have introduced bias? | High risk | ||
| Are there concerns that the included patients and setting do not match the review question? | Low concern | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Unclear | ||
| Could the reference standard, its conduct, or its interpretation have introduced bias? | Unclear risk | ||
| Are there concerns that the target condition as defined by the reference standard does not match the question? | Low concern | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Unclear | ||
| Were all patients included in the analysis? | No | ||
| Could the patient flow have introduced bias? | High risk | ||